MIRROR NEURONS: THE ARENA OF SHEN AND HUN?

In 1992 an Italian neurophysiologist in Parma was doing brain research using macaque monkeys. They were specifically researching an area of the brain called F5, located in the premotor cortex.

      Area F5 contains millions of neurons that specialize in coding for one specific motor behaviour: actions of the hand, including grasping, holding, tearing and, most important, bringing objects (food) to the mouth. As Iacoboni explains "For every macaque these actions are as basic and essential as they come. We Homo Sapiens are grasping and manipulating objects from the moment we fumble for the snooze button in the morning until we adjust our pillows at bedtime. All in all, we perform hundreds, if not thousands, of grasping actions every day."¹ That it why the Rizzolati team chose area F5 for close investigation.
    One day the neurophysiologist Vittorio Gallese was moving around the lab during a lull. A monkey was sitting quietly in the chair; suddenly as Vittorio reached for something, he heard a burst of activity from the computer that was connected to the electrodes surgically implanted in the monkey’s brain. To an experienced neurophysiologist, this signalled a discharge from the pertinent cells in area F5. Vittorio immediately thought that this was strange as the monkey was sitting quietly not grasping anything, yet the neurons affiliated with the grasping action had fired nevertheless.
     Through many other painstaking experiments, the neurophysiologist came to the discovery that, within the F5 motor area, there are dedicated neurons (about 20%) that fire not when one performs an action but when one watches someone else performing an action e.g. grasping, bringing objects (usually food) to the mouth, kicking a ball, playing tennis, etc. They even fire when one simply hears a word such as "kick". Mirror neurons imitating a grasping action fire even when the object grasped is hidden from view (behind a screen), but not if the monkey knows that there is no object.
    Crucially, mirror neurons are involved in predicting the meaning of a certain action: this is essential in communicating and relating to others. Iacoboni says: "The action recognition process implemented [by the mirror neurons] is some sort of simulation or internal imitation of the observed action. Given that our own actions are almost invariably associated with specific intentions, the activation in my brain of the same neurons I use to perform my own actions may also allow me to understand the intentions of other people."²    For example, if I watch someone grasping a cup soon after having an argument with that person, thanks to the mirror neurons, I know whether he or she is grasping the cup to get a drink or whether they are about to throw the cup at me. Quiet simply, mirror neurons differentiate between the same action associated with different intentions.
    After years of experiments by many different neurophysiologists, mirror neurons are now thought to be involved in much more than "imitating" motor actions in one’s brain when watching someone else performing a motor action. They are now thought to be involved in emotional bonding, empathy and language.
It is now thought that mirror neurons play a role in empathy, the capacity to feel other people’s emotions. The brain area connecting mirror neurons to the limbic system (responsible for our emotions) is the insula. In other words, we feel and understand the emotions of other people thanks to our own mirror neurons which are activated by the sight of someone’s smiling, frowning, crying, etc. Thus, "our mirror neurons fire when we see others expressing their emotions, as if we were making those facial expressions ourselves. By means of this firing, the neurons also send signals to emotional brain centres in the limbic system to make us feel what other people feel."³
    Essential to this empathy based on mirror neurons are other people’s facial expressions that trigger the firing of our mirror neurons. To James (of the James-Lange theory of emotions), this phenomenon means that "our mental life is knit up with our corporeal frame, in the strictest sense of the term."⁴ Incidentally, that is the connection between emotions and the Po in Chinese medicine.
    Mirror neurons also play a role in the development of a sense of self. Social context is critical in developing a sense of self. Isolation seems to inhibit the ability to develop a sense of self; rich social context facilitates it. The presence of others, the continuous relations and interactions one must have with others facilitates the development of our sense of self. Mirror neurons fire when we observe actions and when we perform those same actions. There is a strong link between social environment and a sense of self and this link is at least partly due to mirror neurons.
    There is now a mirror neuron hypothesis in relation to autism. In autism there is an "imitation deficit", i.e. the child is unable to translate from the perspective of another individual to one’s own perspective. It is now believed that the key neural deficit in autism is a dysfunction of mirror neurons. As Iacoboni says, "a deeply felt mirroring that moves people closer to each other and makes emotional connectedness possible seems to be the main deficit of patients with autism."⁵
    What has all this to do with Chinese medicine and, in particular, with Shen and Hun? I think there are interesting connections between the role of Shen and Hun and mirror neurons. Shen and Hun together are responsible for emotional empathy and relating to others. Consider the Chinese ideogram for "shen".

    The right side of the ideogram is very interesting: it is pronounced "shen" and it means "to express, to explain, to stretch, to extend".

   The last two meanings, "to stretch" and "to extend", are crucial to an understanding of what the Shen does. It is responsible for "extending" towards others, for connecting with others, for emotional connection and empathy. In other words, for the function of the mirror neurons.
    However, the Shen cannot perform that function alone: it relies on the help of the Hun and that is why ancient books say that Shen and Hun are related work in unison (they are both Yang in nature), as opposed to the relation between Po and Jing (both Yin in nature).
    How does the Hun help the Shen? The Hun is responsible for a different type of consciousness than that of the Shen. It is responsible for intuition, planning, life dreams, ideas, inspiration and, incidentally, also artistic inspiration. How does the Hun perform these functions? Through its movement: the Hun is always moving in the sense of searching, exploring ideas, nurturing life dreams, etc. Without the input of the Hun the Shen would be an inert consciousness. The input of the Hun is therefore essential for the Shen to perform its function of relating and connectedness with others. Again, this is the Chinese medicine equivalent of the function of mirror neurons.
    The movement of the Hun has to be just "right", not too much, not too little. If the movement of the Hun is deficient, the person may become depressed; if the movement of the Hun is excessive, the person may be slightly "manic". I relate autism in children to a deficient movement of the Hun that leads to an impaired function of the Shen in relating to others. As we have seen, this has been related to a dysfunction of mirror neurons.
    Conversely, I relate hyperactivity in children to an excessive movement of the Hun and, interestingly, hyperactive children are often artistic (which is a function of the Hun).
    How does one stimulate the movement of the Hun? I use the Gall-Bladder channel and especially GB-40 Qiuxu. To restrain the movement of the Hun, I use LIV-3 Taichong. Other points that regulate the Shen and Hun and Du-24 Shenting and GB-13 Benshen.

1. Iacoboni M, Mirroring People, Picador, New York, 2009, p. 10.
2. Ibid., p. 30.
3. Ibid., p. 119.
4. Calhoun C, Solomon R, What is an Emotion?, Oxford University Press, 1984, p. 125.
5. Iacoboni, Mirroring People, p. 175.     The left part of the ideogram (by itself pronounced shi) indicates something spiritual, it evokes heaven and stars, also an ancient altar for sacrifices, signs from Heaven. I like the word "numinous" in relation to this quality of Shen.

Herbal Sentinel - Yin: a case history

The Three Treasures remedy Herbal Sentinel - Yin was formulated to strengthen the Wei Qi and therefore resistance to pathogenic factors in persons with either an active Yin deficiency or a constitutional tendency to it.  Usually, Chinese remedies that strengthen the Wei Qi are all Yang tonics and this would not suit someone with a Yin deficiency or a tendency to it.  The following case history, sent by Jason Smith from Spain, is a good example of this.

A 16-year-old boy sought help for various issues. He is a professional basketball player.

First of all, he generally feels cold and this is very much aggravated when he is doing sports (practices at least about 5 hours/day). The cold feeling is accompanied by profuse sweating.

He also complains of severe lumbar pain that started at the age of 13.  His memory is bad and has difficulty retaining names, data, and concentrating.

He reports feeling a “lump” coming out of the stomach into the throat.  His eyes are very itchy.  He feels very tired and experiences a feeling of heaviness of body and legs, where he also experiences pain. He also experiences dry throat in the evening, and drinks cold water. He has also dry and chapped lips.

He wakes up in the middle of the night with unpleasant dreams and occasionally sweats at night.  He has tinnitus all the time and cannot hear well from one ear (varies from one to the other).  He also experiences problems in his right knee.  He complains of  abdominal distension after eating; appetite is good.

There is also asthma with difficulty in inhalation when doing sports, along with a strong propensity to catching colds and spontaneous sweating.

He sometimes feels pain in the lateral rib cage. He has mood swings, ranging from extreme happiness to crying for no reason.

The tongue is slightly red without coating in the centre and front third (Stomach and Lung areas). The tip is red. There are some shallow Stomach cracks in the centre.  There is a yellow rootless coating on the root.

DIAGNOSIS

The patterns involved are Yin deficiency of the Stomach, Lungs and Kidneys with some mild Empty Heat (evidenced by the thirst, feeling of heat during the night and red tongue). The tongue shows the deficiency of Stomach- and Lung-Yin since it lacks a coating in the centre and front third;  the Kidney (Yin) deficiency is evidenced by the memory loss, lumbar pain, tinnitus and fatigue. The dry eyes point out to Liver-Yin deficiency although there are no other symptoms of it.

There is also a secondary Kidney Yang deficiency because of the cold feeling when doing sports, but,  because of the redness of the tongue and the partial lack of coating, the Yin deficiency is predominant and so must be treated accordingly.  The fact that the asthma is on inhalation confirms the fact that the Kidneys are weak.

Lung-Qi is deficient as there is spontaneous sweating and propensity to catching colds.

The feeling of heaviness of the body and legs, along with pain in the legs is due to Dampness in the Cou Li space. The Dampness (Damp Heat) is confirmed by the sticky, rootless, yellow coating at the back of the tongue. This is also evidenced by the abdominal distension after eating.

TREATMENT

The main focus of the treatment was tonifying Kidneys, Lungs and  Spleen.  I chose to tonify Lung- and Kidney-Yin with the Three Treasures remedy Herbal Sentinel - Yin, that tonifies Lung-, Spleen- and Kidney-Qi to strengthen the immune system and also nourishes Lung- and Kidney-Yin. This remedy is meant for people who need a boost to Wei Qi but who have a constitutional Yin deficiency (or tendency to it).

With acupuncture, I used the Ren Mai with the opening and coupled points (LU-7 on left and  KI-6 on right), along with points such as Ren-4, Ren-6, Ren-12, Ren-17, KI-3, KI-7, ST-36.

Three months after the treatment all the symptoms have greatly improved. Sleep is much better, breathing issue is almost resolved, the patient is emotionally much better, the fatigue is also better and the memory is coming back.

The patient also had vitiligo on the medial side of the leg and the ankle. Interestingly, with the above treatment, the area around KI-3 Taixi is starting to regain its colour. The patient also feels his hair is growing much stronger now.  Treatment still continues.

Finally, Giovanni always says that one of his teachers, Dr Shen, always discouraged heavy exercise as he believed it weakens Kidney-Yang. This case is a good example of this.

FOCUS ON A REMEDY: PEACEFUL SUNSET

Chinese geriatrics has been dominated by the idea that aging is due to a decline of Kidney-Jing and therefore the way to slow down aging is to tonify the Kidneys.  Of course this is true, Kidney-Jing does decline with age and, indeed, aging itself is due to such decline. 

However, the major diseases of the elderly i.e. coronary heart disease, cancer and stroke, are due to Full conditions such as Phlegm, Blood stasis, Heat and Internal Wind.  These Full conditions account for most of the morbidity and mortality of the elderly. Nobody dies purely from Kidney deficiency! 

Besides the above three major diseases mentioned above, many of the symptoms and signs of old people are also due to Phlegm and Blood stasis.  For example, it is easy to attribute poor memory in the elderly to a decline of Kidney-Jing (the Kidneys nourish the Brain) and, indeed, it can be.  However, poor memory may also be due to Phlegm obstructing the Brain.  The same applies to dizziness. 

Alzheimer’s disease is another case in point. Of course, it is partly due to the declining Kidney-Jing not filling the Sea of Marrow and not nourishing the Brain.  However, if we look at the pathology of this disease, there are fluid-filled ventricles in the brain: this is a manifestation of Phlegm. There are neurofibrillary tangles and plaques which are also a manifestation of Phlegm. Amyloid fibers aggregate around blood vessels which is a manifestation of Blood stasis.  Thus, in Alzheimer’s disease, besides a Kidney deficiency there is also Phlegm and Blood stasis.

The remedy Peaceful Sunset was formulated for the treatment and particularly prevention of diseases of the elderly due to Phlegm, Blood stasis and Internal Wind. It also nourishes Yin as so many elderly people suffer from Yin deficiency.  This remedy may be used simply for prevention in the elderly and the tongue is a very good indicator for its use.  The tongue indicating the use of this remedy would be:

Swollen = Phlegm

Purple = Blood stasis

Stiff, Moving or Deviated = Internal Wind

Without coating = Yin deficiency

I see many elderly people who are apparently without many symptoms and yet the tongue presents the above features. If the tongue is as described above, the use of Peaceful Sunset is indicated.

The tongue illustrated here is that of an apparently healthy 64-year-old lady who came to me purely for rheumatic aches and pains. She was “healthy” by all accounts and her blood pressure was normal.  And yet, her tongue is Swollen indicating Phlegm, Purple pointing to Blood stasis and Deviated which is due to Internal Wind. Moreover, the coating is missing in parts and the tongue is red which indicates Yin deficiency with Empty Heat.  The combination of all these factors points to the likelihood of this patient suffering a stroke.

There is more on geriatrics in the blog of December 2010.

Maciocia's E-books

Five of my books are now available as e-books on the Kindle platform and two on the Nook platform.

KINDLE:

1) The Psyche in Chinese Medicine
2) The Practice of Chinese Medicine
3) La Pratique de la Medecine Chinoise (French)
4) Les Principes Fondamentaux de la Medecine Chinoise (French)
5) Leitbahnen der Akupunktur (German)

Available here at amazon.com

NOOK:

1) The Psyche in Chinese Medicine
2) The Practice of Chinese Medicine

Available here at barnsandnoble.com

THE TRIPLE BURNER - RELATIONSHIP WITH PERICARDIUM

This is the 6th and last instalment of the discussion on the Triple Burner.

6) Relationship between Triple Burner and Pericardium
Although they are interiorly-exteriorly related, the relationship between Pericardium and Triple Burner is somewhat tenuous: such a relationship is more applicable to the channels, rather than to the organs themselves.

The Nei Jing and Nan Jing always refer to the "5 Zang and 6 Fu" (omitting the Pericardium), but also to the "12 channels" (including the Pericardium). Originally the Pericardium was not considered as separate from the Heart; the two were considered a single organ, which is perfectly logical considering their close anatomical relationship. In fact, when the Ling Shu lists the Yuan points of the 5 Zang in chapter 1, it lists Daling (P-7) as the Yuan point of the Heart.1
A passage from Chapter 38 of the Nan Jing makes it clear that the Pericardium and Heart were, in those times, considered as one organ. It says: "The Zang are 5; only the Fu organs are 6: why is that so? The Fu organs are 6 because of the Triple Burner...it has a name but no form, and its channel pertains to the Hand Shao Yang. [The Triple Burner] is a Fu organ and that is why these are 6."2

This passage is revealing because of its starting question: in fact, the very question "the Zang organs are 5, why are there 6 Fu organs?" implies that it is taken for granted that the Heart and Pericardium are part of the same organ and that therefore it is strange that the Fu organs are 6. The answer explains that the Fu organs are 6 due to the existence of the Triple Burner.

However, within the reply, it says that the Triple Burner "has a name but no form" thus implying that the Triple Burner is different from the other regular Fu organs and their total makes 6 only by adding the Triple Burner.3 The passage also makes clear that the Triple "has a name but no form", i.e. it is not really an organ like the others but a complex of functions: however, it does say that there is a channel associated with it.

Chapter 39 of the Nan Jing is even more specific about the fact that the Triple Burner is not actually associated with a Zang organ: "Each of the Zang organs has a Fu one associated with it. The Triple Burner is also a Fu organ but it is not associated with any of the Zang organs. That is why some say that there are only 5 Fu organs."4

Chapter 25 of the Nan Jing specifically addresses the conundrum that there are 11 Internal Organs but 12 channels: "There are 12 channels but 11 Internal Organs (5 Zang and 6 Fu), why? One channel [jing] has two separate vessels [mai] in the Arm Shao Yin [Heart] and Heart Master [Xin Zhu, Pericardium]. The Pericardium has an Exterior-Interior relationship with the Triple Burner, both have a name but no form [you ming er wu xing], and that is why there are 12 channels." This passage is extremely revealing because it confirms that Heart and Pericardium were seen as one, when it says that one channel [jing] has two separate vessels [mai] in the Arm Shao Yin [Heart] and Heart Master [Xin Zhu, Pericardium].

With regard to the question of 5 Zang and 6 Fu, the author of the Nan Jing seems to be playing games with the reader because, in chapter 39, it says that the Zang could be considered to be 6 and the Fu 5! It says: "There are 5 Zang and yet 6 Fu, how is that? One speaks of 6 Fu but they are actually 5. Although one speaks of 5 Zang, there are actually 6. The Kidneys are two Zang: the left is the Kidney and the right is the Ming Men. The Ming Men houses the Spirit (jing shen). In men it stores the Jing in women it houses the Uterus. The Qi of the Ming Men penetrate the Kidneys. That is why there are 6 Zang. How come there are 5 Fu? [That is because] Each Zang is associated with a Fu, the Triple Burner is a Fu but it does not belong to any of the 5 Zang: that is why there are 5 Fu."5

With the development of the channel theory, the Triple Burner was associated with the Pericardium (given their corresponding position on the arm) and their number totalled 12, including the Triple Burner and Pericardium channels.

Although the Pericardium and Triple Burner channels are exteriorly-interiorly related within the 5-Element scheme, this feels like a somewhat "forced" relationship to make a square shape fit in a round hole, i.e. the 5 Elements into 12 Channels. In fact, some Chinese teachers and doctors go so far as saying that the Pericardium and Triple Burner organs are not interiorly-exteriorly related as the other organs are.

As channels, the Pericardium and Triple Burner channels have a close and symmetrical relationship; they occupy symmetrical positions on the arm. The Triple Burner belongs to the Shao Yang channels which are the "hinge" between the Tai Yang and the Yang Ming channels; the Pericardium pertains to the Jue Yin channels which are the "hinge" between the Tai Yin and Shao Yin channels. Being the "hinge" implies that these channels can connect the Yang and Yin channels, i.e. the Triple Burner connects the three Yang and the Pericardium the three Yin.

The Pericardium and Triple Burner channels are symmetrical in so far as the former provides the opening point of the Yin Wei Mai (P-6 Neiguan) and the latter of the Yang Wei Mai (T.B.-5 Waiguan): the Yin Wei Mai links all the Yin channels and the Yang Wei Mai all the Yang ones. This is another reason why the Triple Burner and Pericardium channels connect the three Yang and three Yin of the arm respectively.

The "Medicine Treasure" even says that the Triple Burner is interiorly-exteriorly related to the Ming Men.6 Since the Ming Men is also called the "Minister Fire", this explains the attribution of Triple Burner to Fire and specifically Minister Fire in the 5-Element context. The Pericardium is obviously closely connected to the Heart and naturally belongs to the Fire element, hence the connection between Pericardium and Triple Burner within the Fire Element and their name of "Minister Fire".

The "Selected Historical Theories of Chinese Medicine" clarifies the relationship between the Triple Burner and Pericardium: "The Heart is the Emperor who has a Minister. The Triple Burner cavities are like a capital which houses both the Emperor and the Minister. The Pericardium in the centre of the chest is like a palace that houses only the Emperor. The palace is inside and is Yin, the capital is outside and is Yang; hence the Triple Burner is a Yang organ and the Pericardium a Yin organ".7

In exploring the relationship between Pericardium and Triple Burner, there is an interesting symmetry between the location of the Back-Shu point of Heart and Kidneys (Shao Yin) and those of Pericardium and Triple Burner. The Heart and Kidneys communicate with each other and their Back-Shu points are BL-15 and BL-23 respectively. The Pericardium and Triple Burner’s Back-Shu points are symmetrical in that they are one point above those of the Heart and Kidneys, i.e. BL-14 and BL-22 respectively.





The Back-Shu point of the Pericardium is naturally just above that of the Heart because of the close anatomical connection between the two organs. The Back-Shu point of the Triple Burner is just above that of the Kidneys because of the Triple Burner being the "envoy" or "ambassador" of the Yuan Qi as it emerges from between the Kidneys (see previous blog post).


Clinical application
There are interesting clinical applications of the Triple Burner and Pericardium channels in the mental-emotional sphere.

First, emotional stress makes the physiological Minister Fire of the Kidneys rise and become pathological: when the Minister Fire is pathological, a person has "Heat". All emotions tend to cause Qi stagnation first and stagnant Qi easily generates Heat: that is why, in mental-emotional stress, the tip of the tongue (reflecting the Heart and the Shen) is red. As we have seen above, chapter 38 of the Nan Jing even says that the Ming Men (same as Minister Fire) is the residence of the Spirit (Jing-Shen). Zhu Dan Xi said: "Not a day goes by in people’s lives that the Minister Fire is not stirred."

The Triple Burner and Pericardium channels affect the mental-emotional state because emotional stress makes the Minister Fire rise towards these two channels; therefore when the Minister Fire is aroused by emotional problems and it rises towards the Pericardium and Triple Burner channels, points of these channels can be used to clear Heat and calm the Mind.
In this context, I use particularly P-6 Neiguan to stimulate the movement of the Hun when the person is depressed, or P-7 Daling to calm the Shen when the person is anxious.


There is another interesting clinical application of the Triple Burner and Pericardium points related to their being "hinge" channels, i.e. the Triple Burner (Shao Yang) is the hinge between Tai Yang and Yang Ming and the Pericardium (Jue Yin) is the hinge between Tai Yin and Shao Yin. Being the "hinge" on a psychological level means that these channels are "mediators" in the sense that they can affect a person's capacity to relate to other people and points of these two channels can therefore be used especially for depression: for this, I use T.B.-3 Zhongzhu and P-6 Neiguan.

1. Ling Shu, p 3.
2. Nan Jing, p. 94.
3. Ibid., p. 94.
4. Ibid., p. 95.
5. Nan Jing, p. 110.
6. Wang Xin Hua 1983 Selected Historical Theories of Chinese Medicine (Zhong Yi Li Dai Yi Lun Xuan), Jiangsu Scientific Publishing House, p. 2.
7. Ibid., p. 161.

Chronic constipation

The following is a case history sent by Jason Smith, a practitioner in Spain.

A 37-year-old woman complained of chronic constipation. She has a bowel movement every 3 days and the problem is aggravated by emotional stress (she works in a lawyer’s office and she finds the work stressful). Occasionally, the bowel movements increase in frequency and she may even go 3 times in one day. The stools are hard and dry.

In the past two months, she developed a distending pain in the abdomen every time she eats. She has a feeling of the food not going down which causes her breathlessness. She has a burning sensation in the epigastrium.

She has abdominal distension after eating, feels sleepy after eating and has a very slow and difficult digestion.

Feels very irritable and feels like crying before the period. She says she feels like crying but is unable to. She reports being very frustrated by her job. She occasionally has a feeling of lump in the throat. Twice she had pain in the coastal region.

At night she experiences tingling and numbness of her legs. She says her memory is bad. She goes through periods of insomnia (both difficulty in falling asleep and waking up in the middle of the night); her periods are very scanty periods and her nails brittle. The periods comes regularly every 32 days and last four days; there are some dark clots but no pain.

She has occasionally a throbbing headache on the temple and behind the eye when stressed at work. Her hair falls out (she says this occurs during the change from spring to summer and summer to autumn).

Her tongue is very thin, slightly reddish purple (especially on the sides) with a yellow rootles coating that is thicker on the root. The tip is very red.

Diagnosis
The patterns involved are Liver-Qi stagnation (constipation, distending pain, costal pain, feeling of lump in throat) as well as Spleen-Qi deficiency and Dampness in the digestive system (difficult digestion, sleepy after eating, yellow coating thicker on the root).

There is also Liver-Blood deficiency (scanty periods, hair falling out, brittle nails, insomnia). The Blood deficiency occasionally gives rise to Liver-Yang rising causing the throbbing headaches.
There is also some Liver-Blood stasis (purpe tongue, dark clots), but this is not a major pattern.

The rootless coating also shows some Stomach-Yin deficiency which causes the burning feeling in the epigastrium.

The pulse is not Wiry which indicates that the Liver-Qi stagnation is secondary to the Liver-Blood deficiency.

There are the interesting symptoms reported of abdominal distension with a feeling of the food not going down which causes her breathlessness: I attribute these symptoms to rebellious Qi of the Chong Mai.

Treatment
She was treated with acupuncture and some Three Treasures and Women´s Treasure remedies. She was prescribed Smooth Passage (morning) to treat the three patterns of Liver-Qi stagnation, Spleen-Qi deficiency and Dampness, and Central Mansion (afternoon) to nourish Stomach-Qi and Stomach-Qi and resolve Dampness. These two remedies were taken every day. Freeing the Moon was added during phase 4.

Two weeks after taking the remedies the bowel movements started occurring on a daily basis, with the stools returning to a normal consistency. Over the following weeks, the patient reported feeling much better and more relaxed on a mental-emotional level, and without any feeling of lump in the throat, reacting "normally under stressful conditions". One month later, the bowel movements where back to normal and she reported feeling "very well, as I hadn´t felt in years." Treatment still is being conducted.

Recurrent bronchitis: a case history

The following is a case history sent by Jason Smith, a practitioner in Spain.

The patient is a 20-year-old girl seeking help because she had a bronchitis three years ago and ever since then she has been very prone to catching colds that always end in bronchitis and pneumonia. Enquiring about how it started, her first bronchitis was after studying very hard to be admitted in university. In the mornings, she coughs and expectorates some phlegm.

She feels cold in general with very cold feet although her hands are always very hot; in the past months she started having a feeling of heat rising up to the head being worst during the acute attacks of bronchitis. Three months ago, she started sweating at night (face and forehead). She also has a dry mouth at night. She used to like warm drinks but now she feels thirsty and needs cold drinks.

Recently she lost weight, losing as much as 10 kg (22 lb) in only three months. She has a pale face but with malar flush (red cheekbones). Her lips are purple. She has bad sleeping habits (goes to bed at 5 am and gets up 2 pm) and for the past three months she wakes up in the middle of her sleep for no apparent reason.

When she has colds she always has a fever, sore throat, profuse sweating, cough and green nasal mucus occasionally with blood. Always shows aversion to wind.

She now feels tired and her legs feel sometime heavy. Her bowel movements are regular (twice a day) but she occasionally has constipation. Her urine is pale but the first one in the morning is dark. She suffers from abdominal fullness after eating. Her appetite is decreased, and she complains that her “stomach is closed”. Has had Candida infections in the past.

In the past three months, she has been getting lower back pain as well as spontaneous sweating and occasional tinnitus.

She feels depressed and her mental state fluctuates, sometimes crying for no reason.
She suffers from throbbing headaches on the lateral sides of head lasting 2 days with nausea: this happens once a month, sometimes with the period but not always. Lately she has experienced floaters.

Her period has always been very irregular (coming between every 15 and 45 days) and extremely painful (before and during) with stabbing pain alleviated by heat. The period lasts 8 days with profuse bleeding (the first four days with heavy bleeding, not much on the 5th day, and profuse the last three days). The menstrual blood is red with clots; brown the last day. She started taking the pill two months ago and her last period was very scanty with brown bleeding.

The tongue is pale and slightly swollen on the sides but slightly red and without coating in the centre. There is a sticky-yellow, rootless coating on the root. The tip is red.

Diagnosis
There are many patterns involved:
1) Deficiency of Lung-Qi (spontaneous sweating, propensity to catching colds).
2) Phlegm in the Lungs (cough and expectoration of phlegm in the morning. This is a residual pathogenic factor that has lingered ever since her first invasion of Wind three years ago with her first bronchitis, and that accounts for the repetitive bronchitis and pneumonia.
3) Kidney deficiency (lower backache, tinnitus, getting thinner, rootless and lack coating). This is a deficiency of both Kidney-Yin and Kidney-Yang as evidenced by the simultaneous cold and hot feelings.
4) Stomach-Yin deficiency with mild empty Heat (tongue red without coating in the middle)
5) Spleen-Yang deficiency (tiredness, abdominal distension).
6) Liver-Blood deficiency (floaters, pale sides of the tongue)
7) Liver-Blood stasis (menstrual clots, purple lips, painful periods)
8) Liver Qi stagnation (moodiness, crying, depression)
9) Liver-Yang rising (throbbing headaches) that is probably due to the Blood deficiency and
Kidney-Yin deficiency
10) Cold in the Uterus (period pain alleviated with application of heat). The Cold in the Uterus leads to Blood stasis.
11) Damp-Heat in the Lower Burner (feeling of heaviness of the legs, candida infection, sticky-yellow coating at the root of tongue).

Treatment
There are many patterns and therefore many treatment options. I decided to start by eliminating the residual pathogenic factor in the Lungs because that is the pattern that is causing the most morbidity. After that has been cleared, I would proceed to treat the other underlying patterns.
She has been given Central Mansion (Three Treasures remedy) to tonify Spleen-Qi, Stomach-Yin and Lung-Qi together with Resolve Phlegm (Little Treasures remedy) to treat the residual pathogenic factor. She has been treated for the past 5 months and she has only had one cold that did not progress any further. The next step will be strengthening the Kidneys.

Note
Note that although Resolve Phlegm is part of the pediatric range Little Treasures, it eliminates residual Phlegm in the Lungs and it can indeed be used in adults.
Finally, please note also how there are four Liver patterns: Liver-Qi stagnation, Liver-Blood stasis, Liver-Yang rising and Liver-Blood deficiency. It is common for the Liver to manifest with several patterns simultaneously: this does not happen with other organs.